New York state health officials this week notified 628 people that they should seek testing for HIV, hepatitis and other bloodborne diseases because between 2000 and 2005 they were treated by a Nassau County, N.Y., anesthesiologist who reused syringes when injecting patients with more than one drug, the New York Times reports.

State health officials began investigating anesthesiologist Harvey Finkelstein of Plainview, N.Y., in 2005 after two of his patients contracted hepatitis C. According to the Times, Finkelstein would use a new syringe for each patient. However, Finkelstein told investigators that in 2000 he began using the same syringe to draw medicine from more than one vial when giving a patient more than one type of drug by injection, which caused the potential contamination of multidose vials. The blood of a patient with one virus could, by backing up through the needle and entering the vials, be transmitted to another person when that vial of medicine was reused.

Investigators in 2005 notified 98 of Finkelstein's patients who had received epidural injections in the three weeks before, during and after his two patients were infected, that they should seek testing for bloodborne diseases. Of the 84 who were tested, no other cases of infection were traced to Finkelstein. The state then expanded its investigation to examine records from 2000 to 2005. New York Health Commissioner Richard Daines in a statement released this week said that "the department identified all 628 patients who had received injections between Jan. 1, 2000, and Jan. 15, 2005, after a thorough review of medical records at all sites where this physician practiced" (Vitello/Kershaw, New York Times, 11/16).

Timing of Notification State health department officials said Thursday that they had planned as early as October 2006 to notify all of Finkelstein's patients that could have been infected with HIV, hepatitis B and hepatitis C, Long Island Newsday reports. However, Finkelstein hired attorneys to avoid submitting all the names of the patients to state and Nassau County officials, and officials then decided against issuing subpoenas. "Initially Dr. Finkelstein was very cooperative," Claudia Hutton, spokesperson for the New York State Department of Health, said, adding, "Then later on he retained an attorney and was not as cooperative."

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Andy Kraus, a spokesperson for Finkelstein, said that the state health department's initial request was "nearly impossible" to fulfill because it asked for "thousands" of records going back more than 10 years. After several months of negotiations with Finkelstein's lawyers, the firm supplied the names electronically to the state in June and July. The state took four months to convert the records to its computer system and to have its notification letter approved by lawyers before they were sent to his patients this week, Newsday reports (Amon, Long Island Newsday, 11/16).

Comments Nassau County Executive Thomas Suozzi called the long delay in making the notifications "outrageous," adding that state health officials were overly deferential in their negotiations with the physician's lawyers (New York Times, 11/16). Hutton said the health department staff "truly don't believe" that they could have notified patients and the public faster than they did. "There are some who would argue we went overboard by doing this letter because the risk of transmission is so low," Hutton said, adding, "We would argue that patients have a right to know if they are put at any risk."

State Sen. Kemp Hannon (R), chair of the Senate Health Committee, announced Thursday that he would hold hearings in December to determine why the notification process was delayed for so long, Newsday reports (Long Island Newsday, 11/16). Michael Duffy, a lawyer who specializes in medical malpractice cases and vice president of the New York State Academy of Trial Lawyers, said that the long delay in notifying Finkelstein's patients is particularly troubling because they will not be able to seek damages in court (New York Times, 11/16).

Finkelstein last week said that he stopped reusing syringes when health officials took note of it. "We have reviewed everything," he said, adding, "The truth will come out" (AP/Syracuse Post-Standard, 11/16).

Editorial Finkelstein's "lax approach to infection control has raised troubling questions about the adequacy of medical oversight in New York state," a New York Times editorial says. According to the Times, state and county health officials have been "justifiably" criticized for moving too slowly to alert Finkelstein's patients of the possible transmission of HIV and hepatitis.

It "seems inexcusable" that it took the state almost three years to notify people under Finkelstein's care that they should be tested for HIV and hepatitis, the editorial says, adding that it will be necessary to determine if the state's investigatory and disciplinary process is "tilted too much toward protecting doctors rather than any patients who may have been harmed." Plans by state officials to eliminate multidose vials "would provide the surest protection against such contamination and not leave patients at the mercy of a doctor's ignorance or carelessness," the editorial concludes (New York Times, 11/17).

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